Evaluation of the pediatric Crohn disease activity index: A prospective multicenter experience

Jeffrey Hyams, James Markowitz, Anthony Otley, Joel Rosh, David Mack, Athos Bousvaros, Subra Kugathasan, M. Pfefferkorn, Vasundhara Tolia, Jonathan Evans, William Treem, Robert Wyllie, Robert Rothbaum, J. Del Rosario, Aubrey Katz, Adam Mezoff, M. Oliva-Hemker, Trudy Lerer, Anne Griffiths

Research output: Contribution to journalArticle

215 Scopus citations

Abstract

Background and Objectives: Longitudinal assessment of disease activity is necessary for studies of therapeutic intervention in children with Crohn disease. The Pediatric Crohn Disease Activity Index (PCDAI) was developed a decade ago for such a purpose, but it function has only been examined in a small number of studies with a limited number of patients. The primary objectives of the present study were to develop cut scores reflecting disease activity as determined by physician global assessment (PGA) and to evaluate the responsiveness of the PCDAI to changes in patient condition after therapeutic interventions. Methods: Data were derived from a prospective database of newly diagnosed children with inflammatory bowel disease established in 2002 at 18 pediatric gastroenterology centers in the United States and Canada. At diagnosis, at 30 days and 3 months after diagnosis, and quarterly thereafter, children (<16 years of age) with Crohn disease had disease assessment performed by PGA and PCDAI. Disease management was provided according to the dictates of the attending gastroenterologist and not by predetermined protocol. Results: 181 patients had concomitant PGA and PCDAI performed at diagnosis, and 95 of these had similar assessment at short-term follow up. Mean ± SD PCDAI scores for mild, moderate, and severe disease by PGA at diagnosis were 19.5 ± 10.4, 32.2 ± 12.7, and 47.8 ± 14.9, respectively (P < 0.001 for all comparisons). Mean ± SD PCDAI for inactive disease after treatment was 5.2 ± 5.4. Receiver operating characteristic (ROC) curve analysis suggested that: 1) activity of moderate/severe disease was best reflected by a PCDAI of ≥30 points, 2) clinical response (moderate/severe disease improving to mild/inactive) was best reflected by a decrease in PCDAI of ≥12.5 points, and 3) a PCDAI < 10 best reflected inactive disease. Conclusions: PCDAI scores accurately reflect disease activity as assessed by physician global assessment. A PCDAI score of ≥30 has acceptable sensitivity and specificity to indicate disease of moderate/severe activity. A PCDAI decrease of 12.5 points or greater following therapeutic intervention accurately reflects a clinically significant response. The PCDAI is an appropriate tool for intervention trials in Crohn disease in children.

Original languageEnglish (US)
Pages (from-to)416-421
Number of pages6
JournalJournal of pediatric gastroenterology and nutrition
Volume41
Issue number4
DOIs
StatePublished - Oct 1 2005

Keywords

  • Activity
  • Children
  • Crohn disease
  • Index
  • Physician global assessment

ASJC Scopus subject areas

  • Gastroenterology
  • Histology
  • Medicine (miscellaneous)
  • Food Science
  • Pediatrics, Perinatology, and Child Health

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    Hyams, J., Markowitz, J., Otley, A., Rosh, J., Mack, D., Bousvaros, A., Kugathasan, S., Pfefferkorn, M., Tolia, V., Evans, J., Treem, W., Wyllie, R., Rothbaum, R., Del Rosario, J., Katz, A., Mezoff, A., Oliva-Hemker, M., Lerer, T., & Griffiths, A. (2005). Evaluation of the pediatric Crohn disease activity index: A prospective multicenter experience. Journal of pediatric gastroenterology and nutrition, 41(4), 416-421. https://doi.org/10.1097/01.mpg.0000183350.46795.42